檳榔嚼食者的認知神經科學取向研究：系統性回顧

Cognitive Neuroscientific Approach in Betel-quid Chewers: A Systematic Review

世界衛生組織認為檳榔果實及其添加物可能致癌，且檳榔嚼食者可能對檳榔產生依賴。儘管亞洲各國有許多嚼食人口，檳榔仍然是成癮物質領域的孤兒。本文系統性地回顧檳榔嚼食者的認知神經科學取向的研究，了解嚼檳榔對於嚼食者的認知功能以及大腦的影響。本文納入1976 至2019 年，共計25 篇相關論文。根據主題以及研究工具，區分為「認知功能」與「執行控制與酬賞系統」。其中「認知功能」分為警覺、選擇性注意力、短期記憶與執行控制能力。「執行控制與酬賞系統」主要為採用磁振造影為工具的研究，探討執行控制與酬賞系統的平衡。本文發現：（1） 嚼食者的警覺研究結果不一致且數量少，無法確認嚼檳榔是否會即時影響警覺；（2） 嚼檳榔會即時影響空間注意力分布，可促進目標辨識；（3） 重度嚼食者會對檳榔相關線索產生注意力偏誤；（4） 長期重度檳榔嚼食可能損傷空間短期記憶；（5） 執行控制能力的行為研究數量極少且結果不一致；（6） 腦造影研究大致上發現檳榔依賴者可能有執行控制能力的缺損，而酬賞系統則無一致的發現。綜觀過去檳榔嚼食者的認知神經科學研究，本文探討幾項研究限制，供未來研究參考。

"The World Health Organization regards betel quid (BQ) as a human carcinogen. The BQ chewers may develop dependence symptoms. Although chewing BQ is common in many Asian countries, BQ is still a “populous orphan” in the field of addictive substance. The current review paper systematically reviews the cognitive neuroscientific studies on BQ chewers to understand the chewing effect on cognitive functions and brain. This review includes 25 studies ranged from 1976 to 2019. According to the subjects and study tools, these studies are categorized into “cognitive functions” and “executive control and reward systems.” The “cognitive functions” session includes alertness, selective attention, short-term memory, and executive control. The “executive control and reward systems” session includes the studies that adopted the magnetic resonance imaging to investigate the possible imbalance between the executive control and reward systems. The current review shows that (1) the alertness studies on BQ chewers are few and inconsistent, (2) chewing BQ can affect spatial attention distribution that facilitates target identification, (3) dependent chewers can bias their attention to BQ cues, (4) dependent chewers may have impaired spatial short-term memory, (5) the behavioral studies on executive control are few and inconsistent, (6) imaging studies, in general, show deteriorated executive control in dependent chewers, but show inconsistent patterns on the reward system. The current review discusses several research limitations for future BQ studies."